Comparative study of tubularized incised plate (tip) urethroplasty versus urethral advancement techniques in distal hypospadias repair: A retrospective multicenter observational study.
DOI:
https://doi.org/10.51168/sjhrafrica.v7i3.2580Keywords:
Hypospadias, TIP urethroplasty, urethral advancement, pediatric urology, surgical outcomesAbstract
Background:
Distal hypospadias is one of the most common congenital anomalies of the male urethra. Surgical correction aims to achieve functional and cosmetic normalcy. Among various techniques, Tubularized Incised Plate (TIP) urethroplasty and urethral advancement procedures are widely practiced. However, comparative data regarding outcomes remain variable.
Objective:
To compare surgical outcomes, complication rates, and cosmetic results between TIP urethroplasty and urethral advancement techniques in distal hypospadias repair.
Methods:
A retrospective multicenter study was conducted across IMS & SUM Hospital-II and SCB Medical College, Odisha, India, from April 2024 to February 2026. A total of 62 patients with distal hypospadias were included. Patients were divided into two groups: TIP urethroplasty (Group A, n=31) and urethral advancement (Group B, n=31). Outcomes assessed included operative time, complications (urethrocutaneous fistula, meatal stenosis, wound infection), and cosmetic appearance (HOSE score).
Results:
A total of 62 patients were included, with comparable demographic characteristics between groups. The mean age was 4.2 ± 1.8 years in the TIP group and 4.5 ± 2.0 years in the advancement group. TIP urethroplasty demonstrated a significantly lower complication rate (16.1%) compared to urethral advancement (35.5%) (p=0.041). Cosmetic outcomes were significantly better in the TIP group (HOSE score: 14.2 ± 1.3 vs 12.8 ± 1.7, p=0.003). Operative time was slightly longer in TIP but not statistically significant.
Conclusion:
TIP urethroplasty demonstrates better cosmetic and functional outcomes with fewer complications compared to urethral advancement techniques in distal hypospadias repair.
Recommendation:
TIP urethroplasty should be preferred for distal hypospadias repair due to its superior cosmetic outcomes and lower complication rates. Further large-scale prospective studies are recommended.
References
Baskin LS, Ebbers MB. Hypospadias: anatomy, etiology, and technique. J Pediatr Surg. 2006;41(3):463–472.
Duckett JW. Hypospadias. Pediatr Clin North Am. 1987;34(5):1259–1274.
Springer A. Assessment of outcome in hypospadias surgery: a review. Front Pediatr. 2014;2:2–10.
Snodgrass W. Tubularized incised plate urethroplasty for distal hypospadias. J Urol. 1994;151(2):464–465.
Borer JG, Retik AB. Current trends in hypospadias repair. Urol Clin North Am. 2002;29(2):353–365.
Snodgrass WT. Tubularized incised plate urethroplasty for distal hypospadias: technique and outcomes. Urol Clin North Am. 2010;37(2):167–175.
Holland AJ, Smith GH. Effect of the depth and width of the urethral plate on tubularized incised plate urethroplasty. J Urol. 2000;164(2):489–491.
Mathieu P. Traitement en un temps de l’hypospadias balanique et juxtabalanique. J Chir (Paris). 1932;39(6):481–486.
Mollard P, Castagnola C. Hypospadias repair using urethral advancement. Eur Urol. 1990;17(1):30–34.
Braga LH, Pippi Salle JL, Lorenzo AJ. Comparative analysis of tubularized incised plate versus onlay flap urethroplasty. J Urol. 2007;178(4 Pt 2):1451–1456.
Cheng EY, Vemulapalli SN, Kropp BP. Snodgrass hypospadias repair with vascularized dartos flap: the perfect repair? J Urol. 2002;168(4 Pt 2):1723–1726.
Elbakry A. Further experience with the tubularized incised urethral plate technique for hypospadias repair. BJU Int. 2002;89(3):291–294.
Sarhan OM, El-Ghoneimi A, Hafez AT. Factors affecting outcome of tubularized incised plate urethroplasty. J Urol. 2009;182(4 Suppl):1741–1746.
Xu Y, Sa YL, Fu Q. Outcomes of tubularized incised plate urethroplasty: a systematic review. Asian J Androl. 2013;15(5):653–657.
Chen SC, Yang SS, Hsieh CH. Comparison of hypospadias repair techniques: a single-center experience. Pediatr Surg Int. 2005;21(9):748–751.
Snodgrass WT, Bush NC. Primary hypospadias repair techniques: a review of the evidence. Urology. 2016;88:1–7.
Holland AJ, Smith GH, Ross FI. HOSE: an objective scoring system for evaluating cosmetic outcomes in hypospadias surgery. J Pediatr Surg. 2001;36(9):1363–1366.
Hadidi AT, Azmy AF. Hypospadias surgery: an illustrated guide. Berlin: Springer; 2004.
Bhat A, Sabharwal K. Comparative study of TIP versus Mathieu repair in distal hypospadias. Indian J Urol. 2008;24(3):320–324.
Duckett JW, Snyder HM. The MAGPI hypospadias repair. J Urol. 1991;146(2 Pt 2):519–522.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Rojalin Mishra, Pritam Pritish Patnaik
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
